Beyond ratios - flexible and resilient nurse staffing options to deliver cost-effective hospital care and address staff shortages: a simulation and economic modelling study
dc.contributor.author | Griffiths, P | |
dc.contributor.author | Saville, C | |
dc.contributor.author | Ball, JE | |
dc.contributor.author | Jones, J | |
dc.contributor.author | Monks, T | |
dc.date.accessioned | 2021-03-08T09:04:35Z | |
dc.date.issued | 2021-02-11 | |
dc.description.abstract | Background In the face of pressure to contain costs and make best use of scarce nurses, flexible staff deployment (floating staff between units and temporary hires) guided by a patient classification system may appear an efficient approach to meeting variable demand for care in hospitals. Objectives We modelled the cost-effectiveness of different approaches to planning baseline numbers of nurses to roster on general medical/surgical units while using flexible staff to respond to fluctuating demand. Design and setting We developed an agent-based simulation, where hospital inpatient units move between being understaffed, adequately staffed or overstaffed as staff supply and demand (as measured by the Safer Nursing Care Tool patient classification system) varies. Staffing shortfalls are addressed by floating staff from overstaffed units or hiring temporary staff. We compared a standard staffing plan (baseline rosters set to match average demand) with a higher baseline ‘resilient’ plan set to match higher than average demand, and a low baseline ‘flexible’ plan. We varied assumptions about temporary staff availability and estimated the effect of unresolved low staffing on length of stay and death, calculating cost per life saved. Results Staffing plans with higher baseline rosters led to higher costs but improved outcomes. Cost savings from lower baseline staff mainly arose because shifts were left understaffed and much of the staff cost saving was offset by costs from longer patient stays. With limited temporary staff available, changing from low baseline flexible plan to the standard plan cost £13,117 per life saved and changing from the standard plan to the higher baseline ‘resilient’ plan cost £8,653 per life saved. Although adverse outcomes from low baseline staffing reduced when more temporary staff were available, higher baselines were even more cost-effective because the saving on staff costs also reduced. With unlimited temporary staff, changing from low baseline plan to the standard cost £4,520 per life saved and changing from the standard plan to the higher baseline cost £3,693 per life saved. Conclusion Shift-by-shift measurement of patient demand can guide flexible staff deployment, but the baseline number of staff rostered must be sufficient. Higher baseline rosters are more resilient in the face of variation and appear cost-effective. Staffing plans that minimise the number of nurses rostered in advance are likely to harm patients because temporary staff may not be available at short notice. Such plans, which rely heavily on flexible deployments, do not represent an efficient or effective use of nurses. | en_GB |
dc.description.sponsorship | National Institute for Health Research (NIHR) | en_GB |
dc.identifier.citation | Vol. 117, article 103901 | en_GB |
dc.identifier.doi | 10.1016/j.ijnurstu.2021.103901 | |
dc.identifier.grantnumber | 14/194/21 | en_GB |
dc.identifier.uri | http://hdl.handle.net/10871/125049 | |
dc.language.iso | en | en_GB |
dc.publisher | Elsevier | en_GB |
dc.rights | © 2021 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/) | en_GB |
dc.subject | Costs and cost analysis | en_GB |
dc.subject | Computer simulation | en_GB |
dc.subject | Cost savings | en_GB |
dc.subject | Health care economics and organizations | en_GB |
dc.subject | Hospital information systems | en_GB |
dc.subject | Nursing staff | en_GB |
dc.subject | Hospital | en_GB |
dc.subject | Patient classification systems | en_GB |
dc.subject | Personnel staffing and scheduling | en_GB |
dc.subject | Nursing administration research | en_GB |
dc.subject | Operations research | en_GB |
dc.subject | Patient safety | en_GB |
dc.subject | Quality of health care | en_GB |
dc.subject | Safer Nursing Care Tool | en_GB |
dc.subject | Workload | en_GB |
dc.title | Beyond ratios - flexible and resilient nurse staffing options to deliver cost-effective hospital care and address staff shortages: a simulation and economic modelling study | en_GB |
dc.type | Article | en_GB |
dc.date.available | 2021-03-08T09:04:35Z | |
dc.identifier.issn | 0020-7489 | |
exeter.article-number | 103901 | en_GB |
dc.description | This is the final version. Available on open access from Elsevier via the DOI in this record | en_GB |
dc.description | Data availability statement: This paper draws on research and data reported in more detail in the NIHR Journals Library Health Services and Delivery Research. The data for this paper consist of anonymous ward and hospital parameters and simulation results. All data requests should be submitted to the corresponding author for consideration. Access to available anonymised data may be granted following review. The simulation model and accompanying documentation are available from the author on reasonable request. | en_GB |
dc.identifier.journal | International Journal of Nursing Studies | en_GB |
dc.rights.uri | https://creativecommons.org/licenses/by/4.0/ | en_GB |
dcterms.dateAccepted | 2021-02-04 | |
rioxxterms.version | VoR | en_GB |
rioxxterms.licenseref.startdate | 2021-02-11 | |
rioxxterms.type | Journal Article/Review | en_GB |
refterms.dateFCD | 2021-03-08T09:03:18Z | |
refterms.versionFCD | VoR | |
refterms.dateFOA | 2021-03-08T09:04:40Z | |
refterms.panel | A | en_GB |
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This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)